CHICAGO, IL USA (UroToday.com) - Drs. Maha Hussain and Howard Scher, two leaders in the field of prostate cancer, presented opposing views regarding whether docetaxel chemotherapy should be incorporated early versus late during the treatment of men with advanced prostate cancer.
Dr. Hussain focused on data from several recently released studies, including STAMPED, CHAARTED, and GETUG-AFU 15. She noted that STAMPED and CHAARTED convincingly demonstrate that use of hormonal therapy with upfront docetaxel is associated with a significant survival advantage over hormonal therapy alone in men with hormone sensitive metastatic prostate cancer. She stressed that using biomarkers, like burden of disease, to deliver treatment to the men who may benefit most from treatment is critical. She also emphasized that because performance status declines over time, earlier treatment with chemotherapy may allow more men to gain exposure to chemotherapy.

Dr. Scher advocated for later incorporation of docetaxel into the treatment algorithm. He noted that the CHAARTED data have not yet been published, and as such have been through the peer-review process to assure that they would stand in the face of scrutiny. He cautioned that changing practice based on data presented only in abstract form could be detrimental to patient outcomes, particularly because many patients treated in the “real world” are inherently less robust than those included on clinical trials. He also stressed that the improvement in overall survival seen in the CHAARTED study may be due to patients in the docetaxel arm having greater exposure to other disease modifying treatments (including abiraterone acetate and enzalutamide) than men in the hormone therapy alone arm.

In the end, the guidelines regarding timing of treatment with chemotherapy are not specific. As a field, we eagerly await the publication of the CHAARTED and STAMPED results, and continued analysis of the GETUG-AFU 15 data. Until we have more information, the decision regarding optimal timing of chemotherapy remains in the hands of the treating oncologist, and personalization of therapy based on clinical factors and patient preferences is the standard of care.